Cairo, 8 year old staffordshire bull terrier just diagnosed

I don't have his results in any paper form so I've went hunting for what I had.

His first stim test after diagnosis and being on 120mg was 88

He was left on 120mg but our vet was on holiday and it was a different vet that did his next stim test.

Cortisol was 133 on that stim test and that vet said to leave him on the 120mg.

His next stim test was done by our normal vet and she phoned urgently to say that his cortisol levels were only 17 and we were to stop his vetoryl for 10 days and repeat the stim test.

Next stim test was over 700 (can't remember the exact number) so she started him on 60mg this time and repeat stim test was to be done after 3 weeks.

Results after that were 60 (November 2013 and this was fasted)

January 2014 - 55 (baseline only and he'd been fasted)

February - 67 (this was baseline cortisol only and he'd had his breakfast with his pill - prior to this, we'd been told to fast him but then I found out that he should have been getting food)

These values are all nmol correct? I think that is the unit used in the UK.

Sharlene and molly muffin

Yeah, they are. Just trying to remember the conversion - it is posted somewhere - divide by 27.49?? Is that right?

you divide by 27.59

is first stim test after diagnosis and being on 120mg was 88 (3.18 ug)

He was left on 120mg but our vet was on holiday and it was a different vet that did his next stim test.

Cortisol was 133 (4.82ug) on that stim test and that vet said to leave him on the 120mg.

His next stim test was done by our normal vet and she phoned urgently to say that his cortisol levels were only 17 (0.61ug) and we were to stop his vetoryl for 10 days and repeat the stim test.

Next stim test was over 700 (25.37ug) (can't remember the exact number) so she started him on 60mg this time and repeat stim test was to be done after 3 weeks.

Results after that were 60 (2.17ug)(November 2013 and this was fasted)

January 2014 - 55 (1.99ug) (baseline only and he'd been fasted)

February - 67 (2.42ug) (this was baseline cortisol only and he'd had his breakfast with his pill - prior to this, we'd been told to fast him but then I found out that he should have been getting food)

Was he on pred after that first crash? That could have made his next stim (700nmol) go up a lot, because it is actually the abnormal of all of these.

No, he didn't get put on pred - just told to stop the vetoryl for 10 then repeat test and that's when it went up to over 700.

Having said that - all the previous tests were done fasted as we'd been told he wasn't to get anything to eat - then I discovered on here that he should have been getting his vetoryl with food so prior to the February test, he'd been fasted.

BTW - the vet we saw today (wasn't our usual vet) put his pred up to 10mg twice a day to try and get some improvement in him - is that OK for a 60lb dog?

In my opinion the whole thing started off wrong. This dog should never have been started on 120 mg. This has all been mismanaged by these vets and I thank God your dog is still alive after all this.please make sure you feed him and give his Vetoryl and have the testing completed within 4-6 hours after taking the Vetoryl. Every time you take him for a test take him at the same time of day. Let us know his stim numbers , before doing anything with the dosage no matter what this vet says. Please let him fully recover, then go low and slow with any changes. The 20 mg in the morning and 20 at nite will be a lot safer for him to start back on. Same dogs can have real sensitivities to this drug, so low and slow is your best bet. I feel so bad for this dog. He must feel rotten after all this. There is a lot of experience on this forum, and you can trust what they tell you, we only want to keep your dog safe which is paramount after all this mess. We will all be here to help you every step of the way. Give Cairo a hug for me he sure deserves it! Blessings
Patti

I do appreciate all your advice and every time I went to the vet, I expressed concerns and told her what I'd been told but she was convinced she was doing the right thing going by Dechra's recommendations. When she put him on the 120mg, that was right in the middle of the dosage guidelines and even now, she says that 60mg is the bottom end of the recommended dose for his weight.

It's become obvious that Dechra need to sort out their literature that goes out to vets - they maybe need to instruct vets to start low and slow instead of having them hammering drugs into the dogs.

Nobody feels worse than I do. I can't forgive myself for what's happening to him.

OMG, of course no one feels worse than you do about what Cairo is going through and it's really only because you got him in and demanded that they do the tests that he has made it through this.

I blame Dechra completely for the mess, along with vets, but I can tell you that here in Canada and in the UK it is not like in the states,where you can pick up a phone and talk to Dechra personally about what to do. We can't and are told that they will only talk to the vets themselves and the vets are told they need to speak with the manufacture reps who sell/provide the the medication. They haven't updated their literature and they won't from what I understand. The reps read the same literature by the way that is included in the medication inserts, so we are rather royally screwed on this and have to fight for every little step.

On the forum here, luckily, we keep up with the latest studies and what the universities and professional IMS's are doing with cushings. That is really the only edge that us who are not in the states have, is a forum like this.

In the UK it is even harder to get compounded trilostane. It can be done, but it's not easy and most vets haven't a clue they can or how to go about it. My vet here in Canada didn't have any knowledge about it either, and only when my IMS mentioned it and thank goodness I have that in writing, was trilostane considered an option.

It's darn hard and you have and will continue to be Cairo's champion, I know that.

I'd have to go back through our thread, but was an ultrasound ever done? or is that even an option? It might be worth it to see if it is possible, just to see what is going on inside of Cairo. Something to think about and maybe talk to your vet about.

Even though 60mg is on the low side of the recommendation, what works is unique to any dog, and those are only guidelines. We know that Dechra in the states is no longer starting dogs out at the high end of the range, but at the low. I wish the rest of the Dechra world would get on board and put that info out to every vet. *sigh*

Okay, I'm ranting at this point. I just want you to know that we DO know that you care and are doing your very best for Cairo and we understand that it is sometimes an uphill battle with the vets.

hugs
Sharlene and molly muffin

Thanks Sharlene:) I tried getting in touch with Dechra, and as you said, they won't have anything to do with me.

I think an ultrasound was mentioned at the beginning but if my memory serves me well (which most of the time it doesn't) the vet said that the LDDST indicated pituitary based so it wasn't worth putting him through the ultrasound. I was just saying to my mum tonight though that I wonder if it's worth getting it done. Only problem is that Cairo doesn't sedate well - and I'm convinced that's down to the Cushings - I don't know if I'm right or wrong - but many years ago, I had to get a gastroscopy and I was sedated and don't remember a thing about it - but most recently, since my Addison's diagnosis, I had to get one and they gave me extra steroid before it, sedation and I fought like a mad woman and I reckon it was down to the extra steroid. Anyway, I digress. I think if I can ask her to sedate him and let me be there for the ultrasound so I can keep him calm, that could be an option - but I don't know if they would let me do that. Vets here seem to be a bit funny about you being around when things are getting done - like the vet the other day (not our normal vet) asked if we wanted her to take him away to get his injection - err, no, he stays with us.

I really did try though to get the vet on side about the initial starting dose but because of the Dechra literature, she wouldn't be swayed. I suppose I can see where she was coming from - the manufacturers literature said one thing and the neurotic owner was saying something different. I've no idea how UK vets can be informed about new research in the US if Dechra aren't going to sort out their literature.

Has Dechra US actually stated about the lower starting dose? If they have, I have the urge to write to Dechra UK and rant at them. I did have a look on both sites and the literature seems to be the same.